GOP seizes new data to jump-start co-op attacks

A new map projects the risk of Zika in D.C. and 49 other cities. But first: It's shaping up to be another rough morning for the co-op program.

GOP TO USE NEW DATA TO JUMP-START OLD CO-OP ATTACKS — The Senate Finance Committee's 10 a.m. hearing today centers on Healthcare.gov, but expect Republicans to return to a previous point of attack: CMS's troubled co-op program.

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A GAO report being released this morning finds that more than 500,000 Americans received coverage through co-ops that have since been discontinued. Meanwhile, four of the 11 remaining co-ops had not hit a program benchmark of enrolling at least 25,000 members. Most remain in financial trouble.

— Hatch raises concerns: "With nearly half of the co-ops now closed, the failed experiment has wasted taxpayer dollars and forced patients and families to scramble for new insurance," committee chair Orrin Hatch plans to say in his opening statement today. "With so many co-ops now in financial jeopardy, I believe that CMS should work with, not against states, to safeguard taxpayer dollars."

SCOOPLET: MAINE WARNS OF DIRE FINANCIAL STATE OF CO-OP — Maine's Bureau of Insurance warned CMS in a letter this week that local co-op Maine Community Health Options is at risk of going insolvent, Pro's Jennifer Haberkorn reports. In 2014, Maine was seemingly the strongest co-op in the country but in hindsight, it wasn't rosy. Its 2015 rates turned out to be inadequate. The bureau warned that while the co-op is trying to improve its financial status, anything could happen. The letter: http://politico.pro/1QYVihe

— And Maine's insurance bureau isn't happy with CMS. The state's officials warn that there is no way for Maine to absorb the losses if the insurer were to become insolvent — the costs would be borne by providers and patients. The insurance bureau wants to place the co-op in receivership and cancel a random selection of the co-op's plans in order to reduce its costs.

But the insurance superintendent writes that CMS told him three weeks ago that doing so would violate federal law and could create a "loophole" that undermines the guaranteed renewability of QHPs. "With decisions comes responsibility," he writes, "because CMS's decision has precluded my ability to act as proposed, CMS now must share responsibility for the risk of an outcome we all very much hope to avoid."

— CMS responds: Spokesman Ben Wakana tells PULSE that CMS works with state agencies to ensure the co-ops are well run. "With respect to Maine, we proposed and supported several approaches to solving the state’s concerns, but do not believe it wise for the state to take actions that would have led to 20,000 people unnecessarily losing coverage," he said.

AND SPEAKING OF CO-OPs: LAWSUIT CENTERS ON BROKEN PROMISES — The CEO of Health Republic, the failed Oregon co-op suing the federal, government, arguesthat the feds broke their commitment to make sure the risk corridors would be fully funded, Adam Cancryn writes at S&P Global Market Intelligence. "[Officials] changed the rules of the game big time, and now we can't play that game anymore," Dawn Bonder says. "That game we never would've entered."

ALSO BACK IN CONGRESS TODAY: TURING EXECS — Turing and Retrophin, two drug companies formerly led by Martin Shkreli, will be the focus of the Senate Aging Committee's second hearing on drug pricing. Expect some fireworks, but less media attention: Shkreli won't be testifying this time, although health care's most controversial figure has been knownto tweet his thoughts from time to time. Sarah Karlin-Smith's story for Pros: http://politico.pro/2556M94

The sample effect — Commonwealth offers a hypothetical example of how cost-sharing reductions would reduce the median out-of-pocket costs for a 40-year-old man, which the researchers calculate would be $6,500 for a high utilizer.But because of the extra assistance, those costs would fall to

— $4,949 for a man earning $25,000— $650 for a man earning $17,000

THIS IS THURSDAY PULSE — Where after Super Tuesday and Supreme Wednesday, we're settling in for a Mad Thursday. PULSE's upset pick in the NCAA tournament: Yale over Baylor in the 2:45 p.m. game. Send tips and side-bets toddiamond@politico.com or @ddiamond on Twitter, and with help today from Paul Demko, Jennifer Haberkorn and Rachana Pradhan.

ICYMI: MERRICK GARLAND's SLENDER HEALTH CARE RECORD — President Obama's nominee to the Supreme Court doesn’t have much of a record on the controversial issues of reproductive health care or the Affordable Care Act, Pro's Jennifer Haberkorn points out. Garland does have a slightly more extensive history ruling on issues affecting hospitals and HHS, Lisa Schencker observes at Modern Healthcare; one expert notes that Garland often sides with government agencies.

DO PATIENT-CENTERED MEDICAL HOMES WORK? — The National Committee for Quality Assurance's Michael Barr thinks so: He points to a new Annals of Internal Medicine study that found a New York PCMH lowered hospitalizations and other utilization measures.

To be clear, the effects were modest, and Barr concedes that "performance on the quality measures was not very impressive," but he argues that the practices were aiming for the utilization metrics laid out by the project organizers.

"This is a good example of what is possible from well-organized, comprehensive primary care practices when given enough time for the transformation, ongoing technical assistance, and appropriate financial incentives," Barr concludes.

** A message from PhRMA: Diabetes is one of the leading causes of death in the United States today. But with more than 170 innovative medicines in development for type 1 and type 2 diabetes, patients have more hope than ever before. Learn more here. **

HOW MICHELLE OBAMA IS CHANGING THE FOOD INDUSTRY — The first lady's sophisticated and strategic campaign to change how Americans eat and exercise has set in motion a series of big changes that will prove difficult to reverse, if they’re reversible at all. And in a new piece for POLITICO magazine, Darren Samuelsohn and Helena Bottemiller Evich found a still-evolving legacy that dovetails — by design — with the president’s far more controversial accomplishment, the Affordable Care Act. Read the story: politico.pro/1QZJrzL

The Coalition to Protect Patient Choice wants the Obama administration to block Anthem’s acquisition of Cigna and Aetna’s takeover of Humana. Their primary arguments: mergers are irreversible, they will decrease competition permanently, and past consolidation has led to higher prices for consumers. Diana Moss, president of the American Antitrust Institute, argued that one justification insurers give for why they need to get bigger — to level the playing field with hospitals — doesn’t hold water. “Bargaining is not a good substitute for competition,” Moss said.

— Topher Spiro, vice president for health policy at the Center for American Progress, pointed out that Aetna and Humana now directly compete for Medicare customers in more than 500 counties. That’s up from just 82 counties where they competed three years earlier. That means the chief tool DOJ has utilized to preserve competition in past deals — forcing plans to sell off blocks of business — would need to be done on an unprecedented scale. “Comparatively it’s off the charts,” Spiro said. “These divestitures are really unlikely to work.”

MAP: ZIKA IS COMING — New research in PLOS Current Outbreaks projects the relative risk of a Zika outbreak in 50 U.S. cities, based on factors like climate and travel. In short: Bad news, Miami. Good news, Minneapolis.

WHO AMERICANS BLAME FOR THE OPIOID EPIDEMIC: OPIOID USERS AND DOCTORS — That's according to a new Harvard T.H. Chan School of Public Health-STAT News poll out today, where 37 percent of Americans tell pollsters that opioid users are to blame for the opioid epidemic. In contrast, 34 percent of respondents pinned the blame on doctors, 10 percent blamed pharma companies and just 7 percent blamed the FDA. http://bit.ly/255KQdZ

WHICH STATES ARE SIGNING UP THE MOST OBAMACARE ELIGIBLES? — The District of Columbia has enrolled the highest percentage of people believed to be eligible for coverage on the exchanges, according to an updated analysis from the Kaiser Family Foundation that includes data from 2016 open enrollment.

In Washington, D.C., 74 percent of the potential exchange population selected a plan. Florida and Maine closely follow the District, having signed up 66 percent and 65 percent, respectively. Iowa sits at the bottom of the pack, with only 22 percent signing up. Other states to see low sign-up rates include Minnesota, South Dakota, New York and Arkansas. The data: http://kaiserf.am/1pMgqgC

VERMONT FORMALLY SUBMITS OBAMACARE WAIVER REQUEST — Vermont has filed an application to use the ACA's Section 1332 waivers to avoid building a website for its small business exchange, Pro's Rachana Pradhan was first to report.

LAWMAKERS TRUMPET WHITE HOUSE 'CURES' MEETING — Vice President Joe Biden met with House E&C Committee and Senate HELP Commitee leaders on Thursday to discuss the 21st Century Cures Act. "We are seeing a tremendous opportunity for Cures, with our legislative efforts coupled with the ‘moon shot’ and the administration’s Precision Medicine Initiative," E&C Chair Fred Upton, Ranking Member Frank Pallone and Rep. Diana DeGette said in a statement. Cures passed the House months ago, but the Senate has moved much more slowly on a smaller set of bills.

NEW WHITE PAPER ON CHRONIC DISEASE — Out today: Recommendations from the Partnership to Fight Chronic Disease on how to improve access to care, systemic innovation and more. http://bit.ly/21wovBK

MAKING MOVES — Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, is retiring in May after six years at the organization. Joining in Young's place: James Gelfand, who has been serving as director of federal affairs at the March of Dimes, and previous worked at the Chamber of Commerce and served as counsel to Senators Olympia Snowe and Tom Coburn.

TRUMP'S JOURNALISTIC MALPRACTICE? — Two different presidential candidates recently authored an op-ed with this sentence: "Medical care in the American territories and commonwealths has historically lagged far behind the continental states, and Obamacare has only made the situation worse."

So who wrote it — Donald Trump or Ben Carson? Both! The Daily Caller flags how Carson's two-week-old op-ed was repackaged under Trump's name. (H/t Jason Millman)

WHAT WE'RE READING by Paul Demko

Doctors are increasingly finding themselves in the uncomfortable role of enforcing restrictions on opioid prescriptions for patients with chronic pain, reports the New York Times. http://nyti.ms/1Uh77Su

Americans spent $168 million on bug spray last year. That’s expected to double or triple this year. The reason? Fear of Zika virus, explains the Wall Street Journal. http://on.wsj.com/1poZxbm

More than a year has passed since Liberia’s Ebola outbreak began tapering off. But the stress it caused the country’s health care system is allowing other diseases to flourish, STAT reports. http://bit.ly/1QZljMk

States are rewriting laws to make a drug that can be used to stop someone from dying of a heroin overdose easier to obtain, explains Stateline’s Christine Vestal. http://bit.ly/1QXqEov

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with some of the most interesting and influential people in health care.

Before joining POLITICO, Diamond edited the Advisory Board Daily Briefing, served as the Advisory Board's senior director of news and communications and created and hosted the popular Weekly Briefing health care podcast. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has been a guest on NPR's "All Things Considered," the BBC, the NBC Nightly News, the Dan Patrick Show, KQED's "Forum" and other programs. He was recently named a 2015-2016 fellow of the Association of Health Care Journalists.